JP6687595B2 - Positioning device for fixing intramedullary nail to long bone - Google Patents

Description

  The present invention relates to a positioning device for fixing an intramedullary nail to a long bone according to claim 1.

  Intramedullary nails are a known aid for treating long bone fractures. An intramedullary nail is inserted into the intramedullary cavity of the fractured bone to mechanically link the fracture. The intramedullary nail may be designed as a so-called side-locking intramedullary nail. In a barbed intramedullary nail, a barb screw serves to lock the connection between the bone and the barbed intramedullary nail in place.

  To date, in the case of the known intramedullary nails, the lateral screws are placed in the bone at the individual openings of the intramedullary nail in position relative to the intramedullary nail. Precise positioning of the lateral locking screws on the intramedullary nail placed in the long bone during insertion of the intramedullary nail requires extensive experience by the surgeon.

  It is an object of the present invention to provide a positioning device for fixing an intramedullary nail to a long bone.

  The object according to the invention is achieved by a positioning device having the features of claim 1.

  In the description that follows, the terms lateral medullary nail and intramedullary nail are used synonymously.

  The positioning device according to the invention comprises a guide bow with an adjusting device. The adjusting device comprises at least one orienting device. The orienting device is particularly releasably a device that acts on a lateral stop device, such as a lateral stop screw, or a screwdriver, a drill, or a spike wire (a wire for tensioning bone fragments or implants). Designed to receive.

  The guide bow comprises a sleeve guide and the sleeve guide comprises a sleeve. The sleeve is arranged rotatably and / or displaceably with respect to the sleeve guide. Thus, the sleeve guide has, for example, a continuous longitudinal opening or bone (both terms are used synonymously herein).

  The sleeve also has a continuous longitudinal opening, or bone, at or at which the guide device can be or is placed.

  In all of the embodiments described above or below, “may be, may be, may be, may be” or “may have, have” The use of expressions such as “may have” may be understood as synonyms such as “preferably is” or “preferrably has” and the like. It should be and is intended to represent an embodiment according to the invention.

  Whenever a numerical value term is given herein, one of ordinary skill in the art should understand it as an indication of a lower numerical limit. Unless it results in a contradiction obvious to a person skilled in the art, the person skilled in the art should understand that the expression “a” always includes “at least one”. This understanding is also understood by the person skilled in the art as the word "numerical value" may mean "exactly one" in the alternative, if this is clearly technically possible. Equal to. Both apply to the terms representing all numerical values encompassed by the present invention and used herein.

  Preferred developments of the invention are the subject matter of the dependent claims and embodiments.

  In some embodiments according to the invention, the guide device is preferably arranged on the sleeve so that it can be displaced and / or rotated there.

  In some embodiments according to the invention, the guide bow is displaceable relative to the sleeve along the longitudinal axis of the sleeve and rotatable relative to the sleeve about the longitudinal axis of the sleeve. Is located in.

  In some embodiments according to the invention, the guide device comprises a connection for releasably connecting the sleeve to the intramedullary nail.

  In some exemplary embodiments according to the present invention, fixation of an intramedullary nail is understood as connecting the intramedullary nail to a stop screw. The intramedullary nail is fixed to the bone by inserting a stop screw or stop device. The positioning device according to the invention thus serves for fixing. The positioning device according to the invention may also serve, in some embodiments, for fixing respectively or may be used for this purpose.

  The guide bow with the adjusting device comprises a locating device and may be referred to as a locating bow in some embodiments according to the invention. The orientation bow is preferably arcuate at least in part.

  In some embodiments according to the invention, the stop device is a stop screw or stop pin. However, the present invention is not limited to this.

  In some embodiments according to the invention, the receiving device provided for receiving a stop screw with an intramedullary nail is a device having at least one prefabricated through opening for the stop screw. The receiving device may be sleeve-shaped or cylindrical. The receiving device may be composed of several parts and / or several materials (composite material). For example, a plastic ring may be used as a part of the receiving device. The plastic ring can beneficially prevent unintended removal of the stop screws.

  In a particular embodiment according to the invention, the receiving device is an opening or hole in an intramedullary nail.

  In some embodiments according to the invention, the orienting device is made and / or designed to set, position, guide, align, pierce and / or screw the stop device.

  In some embodiments according to the invention, the guide device should be understood as a longitudinally extending device, which is hollow or tubular or, preferably, has a longitudinal through opening. In some embodiments according to the invention, the guide device may also be referred to as a tensioning device or a receiving device for the intramedullary nail, for example for pulling the intramedullary nail against the orienting device, eg against the sleeve. Good.

  In some embodiments according to the present invention, the guide device is a tubular, hollow rod or hollow tube. The guide device may be provided and made with or within a sleeve for manually releasably securing an intramedullary nail.

  In particular, the guide device has at one axial end thereof a handle, knob, or for manually rotating the guide device about its longitudinal axis, for example when screwing the guide device into an intramedullary nail. It may have a similar configuration. The handle or knob may be knurled, for example.

  The opposite end of the guide device may carry a screw, preferably an external thread, or an external thread. The external thread may be adapted to be coupled to the internal thread or the internal thread at the axial end of the nail.

  In a particular embodiment according to the invention, a guide device for introducing a tool is provided and made for a press-fit locking of the receiving device and of the lateral stop device introduced into the receiving device. Press-fit locking may be achieved, for example, by screwing a threaded pin acting on the intramedullary nail to the receiving device.

  In some embodiments according to the invention, the guide device is designed to releasably connect the intramedullary nail to the sleeve.

  In a particular embodiment according to the invention, the guide device is arranged coaxially with the longitudinal axis of the sleeve.

  In some embodiments according to the invention, the sleeve comprises, in particular, a sliding guide on its outer or peripheral surface along which the guide bow or part thereof is moved along or with respect to the sleeve. Good.

  In some embodiments according to the present invention, the term "sliding guide" as used herein refers to a slot, web, recess or groove, each referred to as a slide, and in particular a guide bow. Introduced or pressed into, on or along one device which is

  In some embodiments according to the invention, this sliding predetermines or defines movement of the guide bow relative to the sleeve. The moving function of the sliding guide is determined and specified by the course of the slot, web, recess or groove.

  The sliding guide particularly controls or aligns the orienting device and the stop device received therein, in particular the stop screw, into the prefabricated through-opening for the stop screw of the intramedullary nail. It is preferable to help.

  The sliding guide can generate a compound displacement movement (in the direction of the longitudinal axis of the sleeve) and / or a rotational movement (in the circumferential direction of the sleeve).

  Furthermore, the sliding guide can specify the initial position and / or the final position of the displacement path.

  The sliding guide may be a spiral groove.

  In some embodiments according to the present invention, the sliding portion is made in the sleeve by erosion of the sleeve, a cutting and shaping process such as milling or drilling, or a laser process.

  In a particular embodiment according to the invention, the sleeve is manufactured together with the sliding part by an additional (formative) manufacturing method (such as laser sintering).

  In some embodiments according to the present invention, the sliding portion is manufactured by a deposition method (such as welding).

  In some embodiments according to the invention, the sleeve has at least one snap-in location provided on or in the sleeve.

  The snap-in position can serve to releasably secure or lock the guide bow in or at least one predetermined position associated with the sleeve.

  The snap-in position is preferably not integral with the slide guide and is arranged on one side of the sleeve facing the side of the slide guide, for example at least partly away from the slide guide.

  The snap-in position may be arranged in the circumferential direction of the sleeve, for example, on the opposite side surface of the sleeve rotated by 180 degrees.

  The snap-in position may be a recess in the lateral region of the sleeve. This may be a through opening in the wall of the sleeve.

  For example, the guide bow may be guided along a sliding guide on one side of the sleeve (as viewed in the circumferential direction of the sleeve) by a pin integrated with or inserted into the guide bow. On the opposite side of the sleeve, the guide bow may have a snap-in configuration, which is designed to engage or interact with the snap-in position, preferably snap-in there.

  The snap-in position may be a shape within the sliding portion. This may be a through hole or a through opening in the wall of the sleeve.

  The snap-in position may be designed such that the guide bow can be locked to the sleeve by tightening, snap-in, or form fit.

  The guide bow may be locked in one of the snap-in positions by, for example, bolts or snap-in pins. Thus, the orientation of the guide bow with respect to the sleeve is releasably fixed.

  In some embodiments according to the invention, the guide bow comprises at least one snap-in pin or bolt for releasably snapping the guide bow onto or in at least one snap-in position of the sleeve. . The placement or positioning of snap-in pins in the snap-in position may be referred to as a snap-in configuration. When a snap-in pin is not snapped in, it is also called a non-snap-in configuration. The snap-in pin may be arranged for repeated movement between the two aforementioned positions, a snap-in configuration and a non-snap-in configuration.

  In certain embodiments according to the present invention, the snap-in pins are arranged to be snapped in or positioned manually and / or to be manually released or disconnected again. For such a manual operation, a transmission, a driving device, a sliding portion, a sliding device, or the like may be provided. Manual actuation may be supported or assisted by springs. Alternatively, snap-in and / or release or disconnection may be performed without manual actuation, for example by a spring-supported ball or similar arrangement.

  In some embodiments according to the invention, the snap-in position has flutes circumferentially aligned with the sleeve, the flutes extending in any direction and in the lateral regions of the sleeve. , A recess, or a through opening.

  The flutes may allow the snap-in pin or bolt to be displaced circumferentially of and relative to the sleeve within the limits defined by the shape after snapping the snap-in pin into the snap-in position. The possible displacement of the snap-in pin after snap-in may be referred to as the snap-in pin play in the snap-in position. The play may be predetermined by the shape of the flute, in particular its length. For example, such play can be achieved by a lateral stop screw within a predetermined (one or more sides) limit within a through-opening (eg, slot or hole) for an intramedullary nail lateral stop device. , May be aligned, displaced, or may be positioned.

  In some embodiments according to the invention, the flutes are designed to move or rotate / pivot the stop device or stop screw with play of a predetermined size or circumference. , +/− 10 ° with respect to the center of the through opening of the intramedullary nail, for example, in the circumferential direction of the sleeve.

  In some embodiments according to the invention, the guide bow is provided with a locking device for locking, preferably by hand, with a snap-in pin, in particular a fixing screw, the guide bow being selected relative to the sleeve of the guide bow. It is in the predetermined snap-in position.

  After locking, the guide bow cannot be moved further with respect to the sleeve.

  In some embodiments according to the invention, the sleeve has indicia so that the current position of the guide bow relative to the sleeve can be controlled or monitored.

  The snap-in position or the sliding arrangement on or in the sleeve may be hidden as the guide bow moves in the sliding guide, so that the user of the positioning device according to the invention may find a snap-in position. I cannot see the current or instantaneous position of the guide bow between them or in the sliding part. However, it would be useful to the user to know, for example, in which of several snap-in positions the guide bow snap-in pin is currently located or located. In this regard, the positioning device according to the invention advantageously and easily and simplifies the further positioning of the lateral locking screws in the intramedullary nail. Thus, the sleeve can have an orientation aid for the user, reproducing or reflecting the slide or slide guide in the user's visible area on the surface of the sleeve. In such an embodiment according to the invention, the sliding part is imprinted or visualized on the sleeve in this visible region, for example by engraving with a mirror image.

  In a particular embodiment according to the invention, a guide device for releasably connecting the sleeve to the intramedullary nail is arranged in the sleeve and is preferably arranged coaxially or parallel to the longitudinal axis of the sleeve.

  In order to be able to use the positioning device for fixing an intramedullary nail according to the invention, it is intended that the positioning device be fixedly connected to the intramedullary nail. This coupling arrangement provided for this purpose comprises first and second components.

  The first component may be an anti-twist web groove connection opposite the sleeve and the intramedullary nail. For example, the sleeve has at its axial end at least one, but preferably two, three or more (eg axial) webs, protrusions, pins or steps, which are pithed. The axial end of the inner nail engages a corresponding number (eg, axial) groove, slot, or recess. Alternatively, the intramedullary nail may have a step or the like, and the sleeve may have a groove or the like. It is possible to combine these.

  The sleeve and the intramedullary nail may be releasably coupled after the sleeve and the intramedullary nail have been placed against each other in a twist-proof and preferably in a predetermined manner. This second component can be realized by a guide device. For this reason, the guide device may be arranged within the sleeve and coaxial with the longitudinal axis of the sleeve. The guide device may be inserted through the sleeve and screwed with the internal or internal threads of the intramedullary nail by external or external threads located at the axial end of the guide device. The guide device thus releasably supports the intramedullary nail against the sleeve and thus holds the sleeve within the guide bow, preferably in a predetermined orientation with respect to the guide bow.

  The aforementioned two parts are useful, for example, after the intramedullary nail has been secured with lateral locking screw (s) and then while the intramedullary nail is screwed into the guide device or while the screw is loosened. In addition, it can be achieved that the intramedullary nail does not rotate or swivel or twist in the direction of rotation of the screw. For example, avoiding pivoting or rotation, even in the smallest of degrees, such as in the range of a few degrees, may be beneficial and important for posterior stability of the long bone.

  In some embodiments according to the invention, the guide device is tubular or hollow and is therefore designed to introduce or guide a tool. The tool may be used, for example, to activate or screw (tighten and loosen) a locking or blocking device inside an intramedullary nail. The locking or blocking device may be designed as a tightening screw that secures or tightens the adjustable receiving device for the stop screw.

  For example, tools for screwing or tightening may include internal threaded pins on the intramedullary nail. The tool may be an Allen key. The tool may be configured to apply a torque, such as, for example, in the range of about 5 Nm or 9 Nm, or 5-9 Nm.

  In some embodiments according to the invention, the adjustment device is displaceable, with or without an orienting device that is aligned with the intramedullary nail, along the guide bow with or without restriction. The displacement direction along the guide bow is defined as the x direction. The orienting device is specifically designed to receive a lateral stop device, which is a lateral stop screw, or an instrument acting on the lateral stop device. Therefore, with the positioning device according to the invention, the lateral stop device is moved to overlap on the sleeve along the guide bow in the x direction for later fixing the lateral stop screw to the intramedullary nail, And, the sleeve may be aligned and positioned corresponding to the position of the guide bow with respect to the intramedullary nail corresponding to the sliding guide.

  In some embodiments according to the invention, the guide bow is designed at least partially as a circular bow or in the shape of a circular bow. The adjustment device is thereby displaceable, at least in part, along the circular bow.

  In a particular embodiment according to the invention, the orienting device has one or more openings facing the intramedullary nail and reaching the adjusting device. The opening (s) are designed in particular to receive the stop device or an instrument acting on the stop device, which is arranged in the receiving device of the intramedullary nail.

  In a particular embodiment according to the invention, the guide bow has a stop for limiting the displacement path of the adjusting device along the guide bow. The stop can beneficially improve the maneuverability of the positioning device according to the invention, for example, the adjusting device may be faster or easier to the desired, selected or targeted penetration opening of the intramedullary nail. Can be aligned. Also, the stop may be provided for more proper anatomical positioning of the lateral stop device.

  In some embodiments according to the invention, the orienting device is arranged displaceably in the circumferential direction of the sleeve in the longitudinal direction of the guide bow (x direction) and perpendicular to the longitudinal direction of the guide bow (y direction). By being displaceable in both the x-direction and the y-direction, an instrument that can be connected to the locking device can be moved and positioned in the orienting device within the circular section. The circular surface of this circular portion may be stretched in the x and y directions. The orienting device may be arranged perpendicular to this circular surface. The center of the circle is located in particular in the receiving device for the locking screw of the intramedullary nail, in particular here in the receiving device of the locking screw and the longitudinal axis of the nail (or the longitudinal axis of the sleeve). ) Is located at the intersection with. The intramedullary nail and the positioning device can be correspondingly aligned with each other. The movement of the instrument and its positioning on the circular surface may be compared to the movement and movement of the joystick.

  In some embodiments according to the invention, the orienting device is arranged to be displaceable within and relative to the adjusting device or relative to the guide bow.

  In some embodiments according to the invention, the adjusting device is arranged to be movable in at least a first position, referred to herein as an adjusting position, for moving the locating device relative to the adjusting device or the guide bow. It In at least a second position, here referred to as the fixed position, the adjusting device for fixing the orienting device is not movable with respect to the adjusting device or with respect to the guide bow, but this is especially caused by a friction connection. Can be done.

  The fixing of the orienting device to the adjusting device or to the guide bow is preferably releasable.

  The first position is provided for locating and aligning the stop screw, in particular with the desired receiving device for the intramedullary nail. Once the alignment is complete, the stop screws should then be fixed to the receiving device or to the long bone via the receiving device and the orienting device is fixed to the adjusting device (secondary device). position). In this position, the orienting device cannot be displaced or moved any further with respect to the guide bow. An instrument that is then coupled to the stop screw and positioned on the orienting device can beneficially, simply and reliably lock the stop screw in the desired location within the intramedullary nail and tubular bone.

  The positioning and / or fixing of the orienting device with respect to the adjusting device may be done in different ways. Various embodiments are based in particular on a three-shell model or three-shell configuration. The radial shell may be part of the guide bow. The radial shell may be the adjusting device or a part thereof. In the middle shell between the inner shell and the outer shell, an orientation device is integrated in particular. The inner shell is movable and / or positionable between the outer shell and the inner shell. Fixing the inner shell after positioning and alignment of the orienting device may be done in different ways. An illustrative example of this fixation is described below.

  The first concept of securing the inner shell is referred to herein as the spring pin concept. For example, one or more spring pins integrated into the outer shell presses the inner shell directly or indirectly with its spring force. By such a pressing force, the inner shell is pressed against or against the inner shell, and is brought into contact and fixed by frictional force. This contact pressure may vary based on the number of spring pins and / or the strength of the springs, so that when the positioning and alignment is complete, on the one hand the locator remains mobile and, on the other hand, Then, the frictional force is high enough so that the lateral locking screw can be securely locked.

  The second concept is referred to herein as the flap concept. The outer shell is hinged on one side. The device for fixing or tightening the outer shell to the inner shell is arranged at the opposite side of the hinged outer shell (at the top of the shell). For example, the outer shell may be secured and clamped to the inner and inner shells or to the inner and inner shells by thumbscrews, eccentrics, snap hooks and the like. When the device secures the outer shell to the inner shell, for example by hand tightening the thumbscrew, the inner shell in which the orienting device is located is tightened and immobile. On the other hand, if the device is released, the shell may be moved and thus the orientation device may be positioned and aligned.

  The third concept is referred to herein as the spring concept. The inner shell has two shells radially arranged on top of each other. The two shells, which are arranged on top of each other, are pushed radially apart by a spring arranged between the two shells. Furthermore, at least one of the two shells may have a surface structure, such as a protrusion, which on the opposite side can engage another surface structure radially inside the outer shell. . The surface structure on the inside of the outer shell may be, for example, a hole into which a protrusion engages or snaps in.

  The fourth concept is called the screw concept. The inner shell has two separately made shells, arranged radially on top of each other and connected to each other by screws. Rotation of one of the two shells relative to the second shell causes the shells to either swivel together or swivel apart, depending on the direction of rotation, ie, These intervals will either decrease or increase. When the two shells pivot and separate, the inner shell and the outer shell are rotated and fixed.

  A fifth concept uses the leverage to clamp the outer shell against the inner shell or to release tension. In the basic state, the outer shell presses the inner shell in a rotating state, which is fixed or immobile in this basic state. When the outer shell is pushed radially outward by the lever action or bent outward, the inner shell loosens. The orienting device may be aligned and positioned until the outer shell has returned to its original state and the inner shell has been fixed. The lever action is in particular applied manually.

  Some or all embodiments according to the invention may have one, some, or all of the advantages mentioned above and / or below.

  The positioning device according to the invention beneficially corrects minor misalignments during operation when positioning and / or screwing lateral screws into an intramedullary nail placed in a long bone. It will be possible.

  The position and angle of the holes for the stop screws, as well as the position of the stop screws, are advantageously adapted by the positioning device according to the invention to the individual anatomical and trauma situations even during surgery. Can be done.

  Furthermore, the angle of the locking screws that penetrate the intramedullary nail or reach the intramedullary nail by the positioning device according to the invention can be adjusted, for example, for repositioning the bone fragment or from the anatomical point of view of the bone fragment. It can be modified even during surgery to get the correct fit.

  With the snap-in arrangement of the positioning device according to the invention, the snap-in arrangement is beneficially in place along the longitudinal axis of the sleeve due to the form fit between the bolt of the snap-in arrangement of the guide bow and the sleeve. Can be locked. Furthermore, this form-fitting connection or positive connection is mounted in the circumferential direction of the sleeve by means of an elongated hole in order to provide or enable a predetermined or limited rotation between the guide bow and the sleeve. Alternatively, it may be executed. This allows the surgeon to, within certain limits, intraoperatively align the locking device with the intramedullary nail.

  Position control markings on the sleeve of the guide bow may beneficially assist the surgeon in tracking or monitoring the snap-in position and / or the longitudinal hole along the longitudinal axis of the sleeve. The markings may beneficially visualize the snap-in locations and / or slots or flutes. The orientation of the guide bow relative to the intramedullary nail or the orientation of the through opening for screwing the set screw into the intramedullary nail (indication of the direction of rotation of the guide bow relative to the sleeve and the angle) can thus be beneficially facilitated.

  According to the invention, the positioning device can be releasably, reliably and easily connected to the intramedullary nail to be fixed. Thus, the positioning device can be detached and removed from the fixed intramedullary nail. In this regard, the first component, the web groove connection, can provide anti-twist interlocking with the sleeve and the intramedullary nail. It can be beneficially ensured that the intramedullary nail does not rotate or pivot when the threaded connection between the guide device and the intramedullary nail is screwed or loosened. This is to prevent the intramedullary nail from reaching a dangerous position in the bone through the application of torque when connecting the positioning device to the intramedullary nail or releasing or disconnecting the positioning device from the intramedullary nail. Help to.

  The present invention is exemplarily described with reference to the accompanying drawings, wherein like reference numerals indicate like or similar parts. The following description applies to the respective schematic drawings, which are schematically simplified.

Figure 3 shows a perspective view of a first exemplary embodiment of a positioning device according to the present invention. Figure 2 shows the positioning device of Figure 1 according to the invention with an intramedullary nail, a stop screw and an instrument for inserting the stop screw. 1 shows a part of a positioning device according to the invention with a sleeve and a sliding guide in the sleeve and a snap-in arrangement. 4 shows a part of the positioning device of FIG. 3 according to the invention. 4 shows a part of the positioning device of FIG. 3 according to the invention with a plurality of snap-in positions and indicia for position control. 6 shows components of the positioning device of FIG. 5 according to the invention with a guide bow. 6 shows a guide device having a sleeve connected to an intramedullary nail. 8 shows the guide device of FIG. 7 with an intramedullary nail but without a sleeve. 8 shows the guide device of FIG. 7. 6 shows another embodiment of the positioning device according to the invention, in which the locating device is arranged between the adjusting device and the guide bow by the concept of a spring pin. FIG. 11 shows a detailed view of the adjusting device with the orientation device of the positioning device of FIG. 10. FIG. 12 shows a detailed view of FIG. 11 with the outer shell of the adjusting device removed. 5 shows another embodiment of a positioning device according to the invention. 14 illustrates the snap-in configuration of the embodiment of FIG. 13 in detail. 6 shows another snap-in configuration with a spiral spring. 6 shows another snap-in configuration with leaf springs. 6 shows another snap-in configuration with snap-in pins that are inserted diagonally from above into the sleeve. 6 shows another snap-in configuration with snap-in pins that insert into the sleeve from the side. Figure 3 shows a locator halved of the positioning device. 6 shows an adjusting device with a snap-in device for fixing the orienting device to the guide bow. 1 shows a locating device with a hole arrangement for instruments. 10 shows the positioning device of FIG. 10 in another view. FIG. 23 shows a sectional view of the positioning device of FIG. 22. Figure 23 shows a sectional view of the positioning device of Figure 22 fixing the adjusting device to the guide bow with the flap concept. Figure 5 shows an orienting device movably arranged between the adjusting device and the guide bow by means of a spring concept. 3 shows an orienting device movably arranged between the adjusting device and the guide bow by means of a screw concept. 5 shows another embodiment of a positioning device according to the invention. Figure 6 shows a view of another sleeve without a sliding guide. Figure 6 shows a view of another sleeve without a sliding guide. Figure 6 shows a view of another sleeve without a sliding guide. 7 shows another rotary fastener.

  FIG. 1 shows a perspective view of a first exemplary embodiment of a positioning device 100, viewed obliquely from above. The positioning device 100 comprises a guide bow 1 having a sleeve guide 2, an adjusting device 3 and an orienting device 5, a sleeve 7, and a guiding device 9.

  The guide bow 1 may receive the sleeve 7 in the sleeve guide 2 and may be slid or moved relative to the sleeve 7 about a longitudinal axis 11 of the sleeve 7 and / or in a circumferential direction 13 of the sleeve 7. It may be rotated about the longitudinal axis 11. The sleeve 7 preferably comprises a sliding guide 29 (or a predetermined path) for sliding or rotating the guide bow 1 (see FIG. 5). There is an optional position along the sliding guide 29 (see FIG. 5) and the guide bow 1 can preferably be snapped in at this position using the snap-in arrangement 15.

  If a snap-in arrangement 15 is provided, as in the example of FIG. 1, in some embodiments according to the present invention, the guide bow 1 may or may not be screwed onto the sleeve 7 after full snap-in. It can be fixed by hand with 17, or by other fixing means, or the guide bow 1 can be further rotated and / or moved or slid longitudinally with respect to the sleeve 7. Can be prevented. After being fixed, the guide bow 1 is positioned in its final position for fixing the intramedullary nail with a stop screw (see Figure 2).

  If such a fixing is provided, this is done, for example, via a frictional connection between the locking screw 17 and the sleeve 7, or a form-fitting or positive connection.

  The optionally provided adjusting device 3 is movable in the x direction along the guide bow 1. After the final position of the adjusting device 3 has been reached via the movement, the adjusting device 3 exemplarily, in this embodiment, with the aid of the orienting device 5, which is also a locking screw, or with another fixing device. It may be stable or fixed to the guide bow 1 and / or clamped by a friction connection. For this reason, the orienting device 5 preferably has an easily graspable shape such as the triangle shown in FIG. 1 so that it can be fixed by hand.

  The guide device 9 has an opening (not shown in FIG. 1) at its upper end (see FIG. 1). The guide device 9 also has another opening at its lower end, so that the guide device 9 is a tool 55 for locking or locking the intramedullary nail 19 (also not shown in FIG. 1). Provide or form a continuous cavity for receiving (not shown in FIG. 1, see FIG. 13) or other objects. The longitudinal axis of the guide device 9 preferably extends parallel to the sleeve 7 in which the guide device 9 is received, or is the same as the longitudinal axis 11 of the sleeve 7.

  Further, a positioning assisting portion 27 may be provided to position the lateral stop type screw on the positioning device 100.

  FIG. 2 shows the positioning device 100 of FIG. 1 according to the invention with an intramedullary nail 19, a stop screw 21 and an instrument 23 for inserting the stop screw 21. The instrument 23 is guided through the orientation device 5 and in this example also through at least one part of the guide bow 1.

  Prior to inserting or screwing the stop screw 21 into the intramedullary nail 19, the guide bow 1 may be moved along the longitudinal axis 11 and / or in the longitudinal direction as already described in FIG. It may be rotated in the circumferential direction of the sleeve 7 around the axis 11. Furthermore, the adjusting device 3 may be moved in the x direction along the guide bow 1. This positioning (movement and rotation) is continued until alignment of the intramedullary nail 19 with the targeted or through opening 25 is achieved, and the stop screws 21 are attached to the intramedullary nail 19 and It may be secured to a long bone (not shown in Figure 2) surrounding the intramedullary nail 19. The positioning device 100 according to the present invention advantageously uses a non-screw 21 (and, if appropriate, another non-screw 21) at this position after inserting the intramedullary nail 19 into the long bone. Until the optimal positioning of the one or more stop screws 21 is achieved from the user's point of view, by the orienting device 5 aiming at another through opening 25, or Turn to or lead to this.

  Alternatively, another lateral stop screw 21 ′ may then be screwed into the intramedullary nail 19 through or with the positioning aid 27. These positioning aids 27 do not leave room for positioning along the longitudinal axis of the guide bow 1, so that the fixed, predetermined, and optionally (longitudinal axis 11 (With respect to) vertical or angled, it does not provide positioning into the intramedullary nail 19. These positioning aids 27 may also be referred to as so-called immobile or fixed orientation holes, more precisely the distal stop screws 21 '.

  FIG. 3 shows the interior of a positioning device 100 with a sleeve 7 and a sliding guide 29 in or on the sleeve 7 and a snap-in arrangement 15. The cover that covers the parts of FIG. 3 during use of the positioning device 100 is part of the guide bow 1 but is shown in FIG. 4 for clarity, not in FIG.

  The guide step 31 (or pin), which is simply shown in FIG. 3 as a single piece, is integrated with the guide bow 1 and is part of the sleeve 7 and its part in the sliding guide 29 of the sleeve 7. Through engagement, a form-fitting connection or a positive connection between the guide bow 1 or the sleeve guide 2 and the sleeve 7 is possible. The guide bow 1 is introduced into or along the sliding guide 29 by the guide step 31.

  Alternatively, the guide step 31 may be integrated with or connected to the sleeve 7. In this case, the sliding guide 29 is integrated with the sleeve guide 2 (see FIG. 4).

  The sliding guide 29 is straight on its upper part (see the example of FIG. 3, ie between the upper end of the sleeve 7 and the guide step 31). This linear slide allows the guide bow 1 to be introduced into the sleeve 7 (or the sleeve 7 to be introduced into the guide bow 1) during the assembly of the positioning device 100 according to the invention.

  Alternatively, the guide bow 1 may be otherwise connected or attached to the sleeve 7. For example, the outer diameter of the sleeve 7 in the upper region (above the sliding guide 29) may be smaller than the outer diameter shown in FIG. 3 by twice the depth of the linear groove of the sleeve 7. As a result, the guide step 31 can slide over the entire circumference at the upper end of the sleeve 7.

  The lower part of the sliding guide 29 may be designated as a spiral groove. In this lower region, the sliding guides 29 are not straight or substantially straight and are wound, twisted, looped, etc.

  The guide bow 1 is thus introduced, or at least restricted, into a predefined path by the sliding guide 29 during use. The guide bow 1 may therefore only be moved relative to the sleeve 7 along or limited to the path indicated by the sliding guide 29 and / or slid and / or pivot only in place. And / or can rotate.

  The introduction of the guide step 31 into the sliding guide 29 may also be called form-fitting connection or positive spring groove connection.

  In the example of FIG. 3, a plurality of extension portions 33 are provided at a curved point or a bent point along the sliding guide 29 and as a part thereof. Its longitudinal axis preferably extends approximately or exclusively in the circumferential direction 13 of the sleeve 7, respectively. Such an extension 33 marks or codes a so-called snap-in position 35 on the side of the sleeve 7 opposite the circumferential direction 13, and a bolt or snap-in pin 39, described below, snaps in or engages therein. Can be done. The snap-in position 35 may be designed as a vertical hole in the circumferential direction 13. The snap-in position 35 and its function are described in more detail in FIG. The structure and function of the snap-in arrangement 15 is also described in more detail in FIG.

  FIG. 4 shows a part of the positioning device of FIG. 3 according to the invention inserted in the upper part of the guide bow 1. In this figure, the guide step 31 is arranged integrally with the guide bow 1. The sleeve 7 is received in the receiving portion of the sleeve guide bow 1 and the sleeve guide 2. The sliding guide 29 is hidden by the sleeve guide 2 and only the groove-like extension 33 at the bottom is visible or visible.

  Furthermore, FIG. 4 shows an internal thread 28 with a conical step for receiving the locking screw 17 (see FIG. 1).

  FIG. 5 shows another part of the positioning device 100 of FIG. 3 according to the invention. A plurality of snap-in positions 35 as well as indicia 37 for position control can be seen. The display of FIG. 5 is rotated 180 degrees in the circumferential direction 13 with respect to the display of FIGS. 3 and 4.

  The grooved extension 33, the sliding guide 29 (see FIG. 3), and the indented snap-in position 35 have position controls 37 (“1”, “2”, and “4”, position “3”). It is hidden and invisible). For example, the mark "1" corresponds to the top snap-in position, which is snapped in with the bolt 39 in FIG. This configuration corresponds to that of FIGS. 3 and 4, in which the guide step 31 is shown in the uppermost groove-shaped extension 33 of the sliding guide 29.

  By locking the snap-in arrangement 15 and then the guide bow 1, the snap-in arrangement 15 is integrated and either fixed by a lock on the sleeve 7 or restricted from further movement or rotation with respect to the sleeve 7, which is the sleeve. 7 in a predetermined position and in a pre-defined position, by a form-fitting connection or positive connection between the bolt 39 and the snap-in position 35. Prior to snapping the bolt 39 into the snap-in position 35, the bolt 39 may act on the sleeve 7 by a preload, which is achieved in particular by a spring. The bolt 39 is then introduced (rubbing) along the sleeve 7.

  The snap-in position 35 is designed as an oblong hole, but may have any other shape. In the slot-shaped snap-in position 35, the guide bow 1 can move in the circumferential direction 13 of the sleeve 7 in the slot. The so-called play of the guide bow 1 in the sleeve 7 can facilitate positioning and screwing the lateral locking screw 21 to the intramedullary nail 19 (see Figure 2).

  Position control indicia 37 (“1”, “2”, and “4”) are visual aids to the user of the positioning device 100 for information about the direction of rotation and / or angle of the guide bow 1. , And thus an alignment aid. The user can use these marks 37 to easily determine or determine the state of the snap-in position 35.

  The locking of the bolt 39 to one of the snap-in positions 35 results from the snap-in configuration. In the snap-in condition with the bolt 39 inserted in the snap-in position 35, a tensioning device, such as a double leaf spring 41 as in FIG. 5, pushes the bolt arrangement 43 (corresponding to the extension of the bolt 39). , Snap into or snap into the snap-in position 35. Undesired slipping of the bolt 39 from the snap-in position 35 can thereby be beneficially prevented. The disconnection from the snap-in position 35 is brought about, especially manually, by depressing the lever 45 (or actuating another suitable device), for example by means of a gear connection 47, the bolt arrangement 43 and the bolt 39. Pull out or disconnect. After disconnecting, the guide bow 1 may be moved again with respect to the sleeve 7 along the path of the sliding guide, for example placed in another snap-in position 35.

  FIG. 6 shows the components of the positioning device 100 according to the invention, which are hidden by at least a part of the guide bow 1 as seen in FIG. 5, and as already explained in FIG. Hide 15

  In this example, the guide bow 1 hides all four snap-in positions 35, so that the user is initially unaware of which snap-in position 35 the bolt 39 snaps into. For this reason, the position control mark 37 is provided on the upper surface of the sleeve 7 as necessary. It can be seen from FIG. 6 that the bolt 39 is in the upper snap-in position 35 because the mark 37 indicates or points to “1” or the upper mark 37 compared to FIG.

  FIG. 7 shows a guide device 9 inserted into the sleeve 7 having an elongated hole and connected to an intramedullary nail 19.

  The sleeve 7 is, by way of example, connected to the intramedullary nail 19 by means of two bars 49 (only the front bar 49 is visible in FIG. 7), the bars 49 being formed in the groove of the intramedullary nail 19. It is inserted by fitting connection or positive connection. This connection may be referred to as a spring groove connection. To fix the sleeve 7 to the intramedullary nail 19, an optional screw 51 (external thread) is screwed into the lower end of the guiding device 9 and, if present, into the internal thread of the intramedullary nail 19. The intramedullary nail 19 is thus fixed (fitted) to the sleeve 7 in a way that it cannot rotate or slide. The position of the sleeve 7 relative to the intramedullary nail 19 is therefore preferably fixed both longitudinally and circumferentially.

  FIG. 8 shows the guide device 9 of FIG. 7 without the sleeve 7 and with only the intramedullary nail 19.

  FIG. 9 shows the guide device 9 of FIG. 7 as a single piece with an external thread 51 at the lower end of the guide device 9.

  FIG. 10 shows another embodiment of a positioning device 100 according to the present invention.

  The adjusting device 3 is designed as part of a spherical surface with a circular opening. The form or shape of the adjusting device 3 may likewise have, instead of a spherical surface, a differently designed upper surface, which is merely curved or linear as required.

  The adjusting device 3 is fixed to the guide bow 1 (a more detailed description of this fixing is given in FIGS. 22 and 23).

  An exemplary circular opening in the central or central region of the adjusting device 3 is provided for introducing the orienting device 5 and the instrument 23 (which serves to insert the stop screw 21). The longitudinal axis of the instrument 23 is perpendicular to the spherical surface. An extension of the longitudinal axis of the instrument 23 extends through the center of the hole or through-opening of the intramedullary nail 19.

  The instrument 23 is introduced into the orientation device 5. The orienting device 5 is shaped like a shell, optionally with circumferentially concentrically arranged grooves, notches or protrusions around the central guide of the instrument 23. The orienting device 5 formed in a shell shape may be called a middle shell, and includes an outer shell corresponding to the adjusting device 3 and an inner shell corresponding to the shell-like surface of the guide bow 1 when viewed in the radial direction. Placed in between.

  The orienting device 5, i.e. the inner shell, may be moved or slid between the inside and the outside. In this movement, an optional pin 53, which is supported radially by a spring, engages an annular groove or notch in the orienting device 5. A defined and precise positioning of the instrument 23, and the stop screw 21 is thus possible. The distance between the grooves corresponds to a specific and predetermined deflection of the orienting device 5 and may be indicated in degrees or degrees. In this embodiment, the deflection between the two annular grooves corresponds to an angle or a degree of 1 degree (1 °). This principle or concept in which the pin 53 is supported by a spring and which engages in the groove may be called the spring pin concept.

  The arrangement of the pins 53 radially supported by springs on the radial outer surface of the orienting device 5 is shown in FIG. 2, where the adjusting device 3 (outer shell) is removed for better clarity. ing.

  With the arrangement of FIG. 10, the instrument 23 (and the stop screw 21) is in a central, central, initial position (this initial position is shown in FIGS. 10, 11 and 12, and the zero degree position (0 It is possible to deviate from a desired or predetermined power (or power range), for example by 10 degrees (10 °).

  By means of a combination of an optional form-fitting connection (between the pin 53 and the annular groove of the orienting device 5) or a positive connection and a friction connection (between the inner shell and the outer shell). It allows fixing the position of the device 23 for screwing in or fixing the set screw 21.

  The orientation device 5 may be mounted on the circular portion of the structure disposed below the orientation device 5, if necessary. In this way it can be ensured that the orientation device 5 is preferably introduced at a constant distance from the target point.

  FIG. 11 has an adjusting device 3 (outer shell), an orienting device 5 (middle shell), a guide bow 1 (inner shell), a sleeve 7, an intramedullary nail 19, and an instrument 23 for inserting a lateral locking screw 21. 10 shows a detailed view of FIG. In addition, a non-moving device 23 'is shown for locking or screwing in another side stop screw 21' (the orienting device 3 does not move relative to the guide bow 1).

  12 shows the view of FIG. 11 with the adjusting device 3 (outer shell) removed to show the position of the pin 53 in the orienting device 5 (inner shell).

  FIG. 13 shows another embodiment of a positioning device 100 ″ according to the invention.

  The guide bow 1 is divided into two in this embodiment. The first part (left part in FIG. 13) of the bisected guide bow 1 with the sleeve guide 2 is illustratively straight and extends substantially perpendicular to the longitudinal axis 11 of the sleeve 7. The guide device 9 is introduced into the sleeve 7, which is introduced along the longitudinal axis 11 by a tool 55, for example a hexagonal turner, for example for locking the intramedullary nail 19. It Alternatively, something other than the tool 55 may be guided by the guide device 9.

  The first portion is connected to the second portion (right side portion in FIG. 13) of the guide bow 1. The second part includes the orientation device 5. The connection of the two parts may be achieved, for example, by a connector 57. A snap-in pin 39 (or bolt of snap-in configuration), hidden in the guide bow 1 in FIG. 13 and described in detail as another snap-in configuration 15 ′ in FIG. 4, is introduced into the connector 57. The snap-in pin 39 is preferably actuated or moved by at least one lever 59 or a differently designed arrangement. The function of lever 59 will be described in more detail in FIG.

  The second part of the guide bow 1 comprises an adjusting device 3 as well as an orienting device 5, which is shown in Fig. 13 in an exploded view, i.e. unassembled. In the assembled state, the adjusting device 3 is connected to the connector 57 or the like at the upper end (see the display of FIG. 13) as shown in FIG.

  The adjusting device 3 is connected or fixed to the second part of the guide bow 1, for example at its lower end, by a connecting screw 65.

  The orienting device 5 is fixed by a so-called rotary fastener 67 between the adjusting device 3 and the second part of the guide bow 1.

  Regarding the function of the orientation device 5, refer to the description of FIG. 10.

  FIG. 14 details another snap-in configuration 15 'of the embodiment of FIG.

  The snap-in arrangement 15 ′ is based on the magnetically supported fixing of the snap-in pin 39 to the snap-in position 35. The magnetic coupling is realized by a magnet or magnetic material, or here by two magnets 61, 63, which may be arranged at the outer ends of the snap-in pins 39 and have different polarities facing each other. The first magnet 61 may be connected to the connector 57 and / or the guide bow 1, for example. The second magnet 63 may be connected to the outer end of the snap-in pin 39. The lever 59 may push the two magnets apart, thus disconnecting or withdrawing the snap-in pin 39. To this end, the lever 59 is pushed inward in the direction of the arrow 60, so that the snap-in pin 39 and the magnet 63 are pushed outward by the angled or tilted lever 59.

  FIG. 15 shows another snap-in configuration 15 ′ having a snap-in pin 39, a handpiece 71, a spiral spring 69, and a screw 99. To assemble, the parts A and B are first introduced into the guide bow 1 in the direction of the arrow. Next, the parts D and E (snap-in pin 39, handpiece 71, spiral spring 69) are introduced into the guide bow 1 in the direction of the arrow. Then, the screw 99 (part E) is screwed into the guide bow 1 to fix the snap-in pin 39, the handpiece 71, and the spiral spring 69 to the guide bow 1. During this assembly process, the handpiece 71 is pressed within the angular range through the hollow guide bow 1. Next, the handpiece 71 projects from the guide bow 1 within the angular range. In this snap-in state, the spiral spring 69 is compressed and prestressed. To disconnect the snap-in pin 39 from the snap-in position 35 of the sleeve 7, the snap-in pin 39 is pulled outward by manually pressing the handpiece 71 in the guide bow 1, and the snap-in pin 39 is pulled out of the snap-in position 35. It is pulled out and the spiral spring 69 is further compressed. After repositioning the guide bow 1, the snap-in pin 39 causes one of the snap-in positions 35 of the sleeve 7 by returning the handpiece 71 inward and by loosening the spiral spring 69 until it returns to its original state. Can be snapped back in.

  FIG. 16 shows another snap-in arrangement 15 'having a leaf spring 73 and a lever 75. As shown in FIG. 15, the leaf spring 73 is pulled by pushing down the lever 75 and / or by tension. Simultaneously with the pulling of the leaf spring 73, the snap-in pin 39 is pulled out of the snap-in position 35 by the handpiece 71 and separated therefrom. After the new positioning of the guide bow 1, the snap-in pin 39 may be brought to another snap-in position 35 of the sleeve 7 and locked there.

  FIG. 17 shows another snap-in arrangement 15 ′ with a snap-in pin 39 (the snap-in pin 39 may also be called a plug-in bolt) which is inserted obliquely from the top into a snap-in position 35 of the sleeve 7. Show.

  FIG. 18 shows another snap-in arrangement 15 with a snap-in pin 39 for lateral insertion in the snap-in position 35 of the sleeve 7. The snap-in pin 39 may be fixed after being snapped in by actuating or rotating the handpiece 71 and the optional screw 77.

  FIG. 19 shows the bisected orientation device 5 of the embodiment of FIG. The two parts of the orienting device 5 may be screwed together by screws 79, for example. The outer screw of the halved orientation device 5 on the left side in FIG. 15 is screwed into the inner screw of the orientation device 5 on the right side in FIG. 15.

  The bisected orientation device 5 offers various advantages. For example, a combination of different materials (e.g. introducing a locking device or a device 23, 23 'for inserting locking screws, see Fig. 2 to increase the rigidity of the connector) or the rigidity of the orientation device 5. Is brought about.

  FIG. 20 shows a side view of the adjusting device 3 with a snap-in device 81 for fixing the adjusting device 3 to the guide bow 1. The direction of the arrow indicates the direction in which the adjusting device 3 is closed, locked or snapped into or on the guide bow 1. The snap-in device 81 is elastically deformed or bent, in particular during the snap-in process, so that the snap-in device 81 is hooked onto the guide bow 1 after being snapped in. The snap-in device 81 may be opened elastically or bent upwards for disconnection.

  In the disconnected state, the orienting device 5 may be replaced or adapted, for example.

  FIG. 21 shows another orienting device 5 having a hole arrangement 83 for the instrument 23 (see FIG. 22). For example, in the embodiment of the orienting device 5 in FIG. 11 or 12, the orienting device 5 has only one hole, and the orienting device 5 is between the guide bow 1 and the adjusting device 3 in a third direction in a plurality of directions. Although it is movable in its original position, the orientation device 5 of FIG. 21 is in comparison rotatable only around one axis (the central axis of the cylindrical orientation device 5). This movement limitation may be useful, for example, to limit the angle of the instrument 23 at each hole and thus the angle at which the stop screw 21 is positioned by the positioning device 100.

  The orientation device 5 may be fixed by the lock screw 85.

  22 is another view of the positioning device 100 ′ of FIG. 10 having a guide bow 1, an adjusting device 3, a sleeve 7, an intramedullary nail 19, an orienting device 5 and an instrument 23 for inserting a lateral stop screw 21. Indicates. The annularly arranged grooves shown in FIG. 10 are not shown in the simplified view of FIG.

  The adjusting device 3 is connected to the guide bow 1 by (for example) four (optional) point-like fixings.

  FIG. 23 shows the positioning device 100 ′ of FIG. 22 in cross section.

  24 shows in cross section the positioning device 100 'of FIG. 22 which secures the adjusting device 3 to the guide bow 1 with the flap concept. In this exemplary embodiment, the flap concept has only two (or only one if necessary) point-like fixings 87 on one side of the adjusting device 3. The fixed part 87 may be designed as a joint, for example. On the other side, the adjusting device 3 is connected to the guide bow 1 by means of a thumbscrew 89 (or an eccentric, a snap hook, etc.). By this connection, the adjusting device 3 is pressed or pushed into the guide bow 1, so that the orienting device 5 is clamped or fixed between the adjusting device 3 and the guide bow 1.

  This flap concept exemplarily and advantageously allows the orientation device 5 to be replaced.

  FIG. 25 shows the orienting device 5 movably arranged between the adjusting device 3 and the guide bow 1 by means of the spring concept. In this embodiment, the orienting device 5 has two parts or shells between which the spiral spring 91 is arranged. The upper part (see FIG. 25) is pushed up by the spiral spring 91. As a result, the projection 93 arranged on the upper side is housed or snap-fitted in the lower hole (or groove) 95 of the adjusting device 3. For example, ten protrusions 93 and holes 95 may be arranged on the upper side or the lower side, respectively.

  FIG. 26 shows another orienting device 5 movably arranged between the adjusting device 3 and the guide bow 1 by means of the screw concept. The upper shell of the orienting device 5 may be pressed against the underside of the adjusting device 3 by the screw 97, and the underside of the lower shell of the orienting device 5 may be pressed against and fixed against the upper side of the guide bow 1. May be.

  FIG. 27 shows another embodiment of a positioning device 100 ″ ″ according to the present invention.

  The first portion 1a (of FIG. 27) is particularly releasably connected to the sleeve guide 2. Alternatively, the connection may be a non-releasable material adhesive connection, such as a solder connection, a weld, or an adhesive connection. The material bond, unitary connection may be a unitary piece, for example made of cast and / or machined material. The first portion 1a may be manufactured by a modeling manufacturing method, for example, by a laser sintering method or a high-speed prototype method.

  The second part 1b of the guide bow 1 may be manufactured as one piece or as a plurality of pieces.

  The first part 1a and the second part 1b may be connected to each other at the interface 101 by form-fitting and / or member connection. For example, the second portion 1b may be form-fitted or positively pushed in by a step into the hollow end of the first portion 1a. This form-fitting connection may then be fixed by one or several bolts 103 (bolts 103 may be dowel pins). The form fit and / or member connection may be further secured by gluing. Adhesion may be beneficial to ensure a play-free connection even after extended use and subject to a lot of mechanical stress. A play-free connection may be important for accurate positioning of the intramedullary nail and successful treatment by the positioning device 100 "'according to the present invention.

  The snap-in pin 39, the hand piece 71, the spiral spring 69, and the screw 99 are attached to the guide bow 1 as described in FIG. Also, in the embodiment of FIG. 27, a small pin 105 (the pin 105 may also be referred to as a pin) is fixed or coupled to the snap-in pin 39. The spiral spring 69 and the pin 105 are usually first mechanically elastically deformed so that the spiral spring 69 can be moved or pressed through the pin 105 of the snap-in pin 39. It is designed (in FIG. 27, the spiral spring 69 is moved to the left in the direction of the handpiece 71 by the pin 105). In this way, the spiral spring 69 cannot be individually separated from the snap-in pin 39 without being newly elastically deformed. This has the advantage that sterilization of this configuration can be carried out without removing the spiral spring 69.

  The rotary fastener 67 connects and fixes the orienting device 5 and the adjusting device 3 to the guide bow 1 in the attached state. The rotary fastener 67 is described in more detail in FIG.

  The orienting device 5 includes a concentric ring 109 (on the right side in FIG. 27) on at least one side. These purely visual rings help the user to control or orient the current position of the orienting device 5 and can be moved between the rotary fastener 67 and the adjusting device 3.

  Furthermore, the orienting device 5 has a longitudinal slit 111 on the circumference of the central sleeve-shaped projection. The longitudinal slits 111 serve to elastically deform the annular projection when inserting the instrument 23 for inserting a lateral stop screw (see FIG. 11). In the undeformed state, the inner diameter of the protrusion is slightly smaller than the diameter of the instrument 23. The prongs may be elastically deformed and expanded during insertion of the device 23 and then actively moved or rotated by an action or force exerted on the frictional resistance between the prongs and the device. Good. Due to the frictional resistance, the device can only be moved actively and will not fall out or disconnect. This type of tightening is useful when the device 23 cannot be permanently fixed and held by hand, but still needs to remain in place.

  The second part 1b of the guide bow 1 is provided with a positioning aid 27 as a hole for another instrument 23 '(see Fig. 11) for insertion of a lateral locking screw. The positioning aid 27 also comprises a (hidden) longitudinal slit 113 at one end (on the left in FIG. 27), which has the same function as the longitudinal slit 111. Thus, the device 23 'which is pushed into the hole of the positioning aid 27 is movable on the one hand, but on the other hand it is clamped by frictional resistance in order to prevent it from coming off or disconnecting.

  Furthermore, the second part 1b has holes 115 for connecting pins, in particular dowel pins. Due to the dowel pin, the second part 1b is provided, in particular (for example in FIG. 27), to provide another hole for a positioning aid, for example for inserting another lateral locking screw into the intramedullary nail. (Not)) may be connected to the extension.

  The component shown in Figure 27 may be made of one or different materials. Preferably, the parts of the second part 1b, the adjusting device 3, the orienting device 5, and the rotary fastener 67 are made of plastic, the remaining parts are made of one or a different metallic material. By way of example, plastic parts include PEEK (polyether ether ketone), reinforced PEEK fiber, PEEK fiber reinforced with different concentrations of fiber, polyoxymethylene (POM), carbon fiber reinforced plastic (CFRP), polyallyl sulfone. , In particular one of polyphenyl sulfone (PPSU), or may be made of or comprise various plastics. By way of example, parts made of metal may be made of or include such materials. Stainless steel may be hardened and / or blasted.

  28 is a single part view showing the sleeve 7 of FIG. 27. The longitudinal axis 11 of the sleeve 7 corresponds to the longitudinal axis of the intramedullary nail 19, which is fitted and fixed to the left end (see FIG. 28) by the guide device 9 (see FIG. 13). May be. For example, millimeters are marked on the sleeve to control the penetration depth of the intramedullary nail 19.

  Compared to the embodiment of the sleeve 7 of FIGS. 3 to 7, the sleeve 7 does not have a sliding guide 29.

  29 shows the sleeve 7 of FIG. 28 in a view rotated 90 degrees about the longitudinal axis 11.

  FIG. 30 shows the sleeve 7 in a half sectional view AA corresponding to the section plane shown in FIG.

  The guide bow 1 is positioned with respect to the sleeve 7 by the snap-in pin 39 according to the configuration of the positioning device 100 described above with reference to FIGS. 10 and 15, for example.

  This positioning is achieved here, by way of example, via snap-in pins 39 being able to be positioned in different holes 107 of the sleeve 7, and by means of which positioning the locking screws 21 and the instruments 23, and It is fixed to the intramedullary nail 19 and to the surrounding long bone using the orienting device 5.

  Therefore, the user of the positioning device 100 according to the present invention can select, from the plurality of predetermined holes 107, the hole in which the lateral fixing screw 21 is to be positioned and fixed, and fix the intramedullary nail 19 and the long bone, respectively. it can. In this choice, the snap-in pins 39 should only be moved, for example, possibly only between the predetermined holes 107, so that they can be fast and accurately fixed. To this end, the mobility of the snap-in pin 39 is limited, for example, by the knurled area 119. The direction of movement of the snap-in pin 39 along its longitudinal axis, which is indicated by the arrow 121 in FIG. 28, is optionally limited, for example by means of a stop, so that the snap-in pin 39 is preferably outside the sleeve 7. It will not be pulled out beyond the diameter. The possibility of movement within the region 119 is clearly indicated by the gap 123 in FIG.

  When the positioning device 100 is attached, the hole 107 is hidden by the sleeve guide 2 of the guide bow 1 as necessary. In order to orient the user to the actual position of the snap-in pin 39, a numbered or otherwise indicia 125 is preferably stamped or affixed to the sleeve 7 in the unobscured area. This mark corresponds to each associated hole 107.

  Region 119 of the embodiment of FIGS. 28-30 is merely exemplary. For example, the region 119 may be narrower and smaller to limit the possibility of introducing the snap-in pin 39, and to allow for a faster and more accurate positioning in the hole 107, or for selection.

  The hole 107 is provided with a chamfered portion as needed to facilitate the insertion of the snap-in pin 39 into the hole 107. The plurality of holes 107 are preferably spaced to allow play-free positioning.

  FIG. 31 shows another rotary fastener 67. In this embodiment, the rotary fastener 67 has an asymmetrical mating contour or a peripheral contour or an outer contour, in particular for hand tightening and releasing.

  The optional asymmetric meshing profile of FIG. 31 may be referred to as a sawtooth profile. The rotary fastener 67 is tightened, for example, in the clockwise direction of the rotation direction 129 (in relation to the display in FIG. 31) and released counterclockwise. The side in the clockwise direction is much flatter than the release side. Here, only a small torque can be applied. If the torque is increased too much, the contacting hand or finger will slip past the nub 131 while the user is tightening it by hand. In this way, it may be beneficially achieved that too much torque is not applied to tighten the rotary fastener. Very large torques can cause damage or destruction of this part, which is preferably made of plastic. Preferably, in this embodiment, applying torque to the rotary fastener to release is easier than applying torque to tighten. Therefore, the user can surely manually release the rotary fastener that he or she has fastened by hand.

  Alternatively, a tool may be used instead of completely manually actuating the rotary fastener 67.

  The radii 133 and 135 define different side slopes. As an example, radius 133 may be about 6 mm and radius 135 may be about 49 mm.

100, 100 ′, 100 ″, 100 ′ ″ Positioning device x A direction of movement of the adjusting device along the guide bow, x direction y A direction perpendicular to the moving direction of the adjusting device along the guide bow, the sleeve Circumferential direction of the y direction 1 guide bow 1a first area or part of guide bow 1b second area or part of guide bow 2 sleeve guide 3 adjusting device 5 locating device 7 sleeve 9 guide device 11 sleeve longitudinal axis 13 sleeve Circumferential direction 15,15 'snap-in arrangement 17 locking screw or retaining screw 19 intramedullary nail 21, 21' locking device, locking screw 23, 23 'instrument for inserting locking device or locking screw 25 through opening 27 Positioning assistant 28 Inner screw 29 Sliding guide 31 Guide step or landing 33 Sliding guide in the circumferential direction of the sleeve Grooved extension 35 snap position of (long hole of a sleeve)
37 Position control mark 39 Snap-in pin (bolt with snap-in structure)
41 leaf spring 43 bolt construction 45 lever 47 gear connection 49 sleeve bar 51 screw 53 pin 55 radially supported or elastically supported by spring 55 tool 57 connector 59 lever 60 lever moving direction (arrow direction)
61 magnet 63 magnet 65 connecting screw 67 rotary fastener 69 spiral spring 71 for snap-in pin 71 handpiece 73 leaf spring 75 lever 77 screw for snap-in pin 79 screw for locator divided by 2 or for locator divided by 2 Screw 81 Snap-in device 83 Hole arrangement 85 Lock screw or holding screw 87 Point-shaped or point-shaped fixing part 89 Thumbscrew 91 Orientation device spiral spring 93 Projection on the top of the orientation device 95 Hole or hole on the bottom of the adjustment device 97 Locator screw 99 screw 101 interface between first and second part of guide bow 103 bolt (dowel pin)
105 Pin 107 Sleeve Hole 109 Concentric Ring of Locator 111 Longitudinal Slit 113 of Locator Sleeve-like Protrusion Longitudinal Slit 115 Positioning Aid 115 Hole of Dowel Pin 117 Mark 119 mm Snap-in Pin Movement Range 121 Snap-in Pin Direction of movement 123 gap width for moving the snap-in pin 125 mark 127 chamfer 129 rotational direction of rotary fastener 131 nub 133 first radius of rotary fastener 135 second radius of rotary fastener

Claims (16)

A positioning device for positioning and / or fixing an intramedullary nail to a long bone, comprising:
A guide bow (1),
Adjusting device (3), said adjusting device (3) having at least one orienting device (5), said orienting device (5) being a through opening (25) provided in said intramedullary nail. An adjusting device (3) designed to at least partially receive a locking device (21) to be inserted or screwed into or a device (23) acting on said locking device (21);
A sleeve guide (2) having a sleeve (7), said sleeve (7) being mounted on said sleeve guide (2) such that it can rotate and / or slide with respect to said sleeve guide (2), A sleeve guide (2), the sleeve (7) having a longitudinal through opening for receiving a guide device (9) for releasably fixing the intramedullary nail ;
That Yusuke, equipped with a gas Idobou (1),
The adjusting device (3) is arranged so as to be movable in the longitudinal direction (x direction) of the guide bow (1) together with the orienting device (5), and the orienting device (5) is used for the positioning device (100). , 100 ', 100'') during use and is aligned with the intramedullary nail (19),
The guide bow (1) is at least partly designed as a circular bow and the adjusting device (3) is arranged to be movable at least partly along the circular bow.
Positioning device.   Positioning device (100, 100 ', 100' ') according to claim 1, further comprising a guide device (9) inserted into the sleeve (7).   The sleeve (7) and / or the guide device (9) further comprises a connection for releasably connecting to an intramedullary nail (19). Positioning device (100, 100 ', 100' '). A slide for the sleeve (7) to guide a part of the guide bow (1) along the sleeve (7) or a part of the sleeve guide (2) along the guide bow (1). Positioning device (100, 100 ', 100'') according to any one of claims 1 to 3, comprising a movement guide (29 ). Positioning device (100, 100 ', 100' ') according to claim 4, wherein part of the guide bow (1) or part of the sleeve guide (2) is a guide step (31). The guide bow (1) comprises a snap-in pin (39) movable between at least two positions, the sleeve (7) at least one snap-in for inserting or snapping in the snap-in pin (39). position with a (35), the positioning device according to any one of claim 1 to 5 (100, 100 ', 100''). The snap-in position (35), has a longitudinal groove which is arranged in the circumferential direction (13) of said sleeve (7), wherein the longitudinal groove is, the snap pins (39) of the snap-in position (35) 7. Positioning device (100, 100 ', according to any one of claims 6 to 10, which enables the snap-in pin (39) to be moved in the circumferential direction (13) of the sleeve (7) at one time. 100 ''). Said sleeve (7) has a mark for controlling or monitoring the position of the Gaidobou (1) relative to the sleeve (7) (37), the positioning device according to any one of claims 1 to 7 ( 100, 100 ', 100''). The guide device (9) comprises an external thread (51), The apparatus according to any one of claims 1-8 (100, 100 ', 100''). Positioning device (100, 100) according to claim 9 , wherein the guide device (9) for introducing a tool (55) has a hollow interior, has a longitudinal opening and / or is tubular. 100 ', 100''). Wherein the Gaidobou (1) along said circular bow, said has a stop for limiting the displacement path of the adjusting device (3), the positioning device according to any one of claims 1-10 ( 100, 100 ', 100''). The orientation device (5) is, the facing intramedullary nail (19), and has an open port passing through the adjusting device (3), the positioning device according to any one of claims 1 to 11 (100, 100 ', 100''). The orientation device (5) is, in the circumferential direction (13) of said sleeve (7), displaceable or movable, the positioning apparatus according to any one of claim 1 to 12 (the 100, 100 ', 100 ''). The orientation device (5) comprises disposed adjusting device (3), can be displaced relative to the adjusting device (3), according to claim 1 positioning apparatus according to any one of 13 (100, 100 ', 100''). The orienting device (5) is movably arranged in at least a first position for moving the orienting device (5) relative to the adjusting device (3), and the orienting device (5) is adjusted Positioning device (100, 100 ', 100'') according to claim 14 , wherein the positioning device (100, 100', 100 '') is arranged immovably in at least a second position for releasably fixing it to the device (3). It is releasably connected to the intramedullary nail (19), the positioning device according to any one of claims 1. 15 (100, 100 ', 100'').

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